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Management Strategies Based on Multi-Modality Neuromonitoring in Severe Traumatic Brain Injury

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  • Published:
Neurotherapeutics

Abstract

Secondary brain injury after neurotrauma is comprised of a host of distinct, potentially concurrent and interacting mechanisms that may exacerbate primary brain insult. Multimodality neuromonitoring is a method of measuring multiple aspects of the brain in order to understand the signatures of these different pathomechanisms and to detect, treat, or prevent potentially reversible secondary brain injuries. The most studied invasive parameters include intracranial pressure (ICP), cerebral perfusion pressure (CPP), autoregulatory indices, brain tissue partial oxygen tension, and tissue energy and metabolism measures such as the lactate pyruvate ratio. Understanding the local metabolic state of brain tissue in order to infer pathology and develop appropriate management strategies is an area of active investigation. Several clinical trials are underway to define the role of brain tissue oxygenation monitoring and electrocorticography in conjunction with other multimodal neuromonitoring information, including ICP and CPP monitoring. Identifying an optimal CPP to guide individualized management of blood pressure and ICP has been shown to be feasible, but definitive clinical trial evidence is still needed. Future work is still needed to define and clinically correlate patterns that emerge from integrated measurements of metabolism, pressure, flow, oxygenation, and electrophysiology. Pathophysiologic targets and precise critical care management strategies to address their underlying causes promise to mitigate secondary injuries and hold the potential to improve patient outcome. Advancements in clinical trial design are poised to establish new standards for the use of multimodality neuromonitoring to guide individualized clinical care.

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Acknowledgements

We thank Dirk Traufelder for medical illustration.

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Authors and Affiliations

  1. Division of Neurocritical Care, Departments of Neurology and Neurosurgery, University of Chicago Medical Center, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Christos Lazaridis

  2. Division of Neurocritical Care, Department of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, OH, USA

    Brandon Foreman

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  1. Christos Lazaridis
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Correspondence to Christos Lazaridis.

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Conflict of Interest

Dr. Lazaridis is the University of Chicago site PI for the BOOST-3 clinical trial. Dr. Lazaridis is supported by the Department of Defense CDMRP Log Number: TP210464 Grants.gov ID Number: GRANT13518109 for Prediction and Prevention of Intracranial Hypertension. Dr. Foreman is co-investigator for the INDICT clinical trial (DOD JW200215) and is supported by DOD grants JW200215 and W81XWH1920013. Dr. Foreman receives honoraria and serves on the speaker’s bureau for UCB Pharma, and scientific advisory boards for SAGE Therapeutics and Marinus Pharmaceuticals. He is an unpaid member of the scientific advisory committee for the Neurocritical Care Society Curing Coma Campaign.

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Lazaridis, C., Foreman, B. Management Strategies Based on Multi-Modality Neuromonitoring in Severe Traumatic Brain Injury. Neurotherapeutics 20, 1457–1471 (2023). https://doi.org/10.1007/s13311-023-01411-2

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